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Pancreatitis, Chronic

Robert L. Frachtman, MD and Marni L. Martinez, APRN Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Long-standing and progressive destruction of pancreatic tissue due to persistent inflammation

  • Results in exocrine and/or endocrine insufficiency

  • Major features

    • Pain

    • Malabsorption

    • Diabet...

DIAGNOSIS

As with acute pancreatitis, symptoms do not always correlate well with objective findings (imaging, amylase/lipase). 

HISTORY

  • Epigastric pain, often radiating to the back

  • Flare-ups may mimic ac...

TREATMENT

MEDICATION

First Line

Analgesics (no consensus on specific drugs or doses) 
  • Tramadol 50 mg q6h PO is commonly used as a first line.

  • Chronic opioid (morphine, fentanyl) therapy may be required in...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Depends on the source of the pain and whether a ductal disruption exists 

DIET

  • Small meals high in protein, ~20 g/day of fat; adjust for diabetes; patients with dec...

REFERENCES

1
Forsmark CE. Management of chronic pancreatitis. Gastroenterology.  2013;144(6):1282.e3–1291.e3. [View Abstract on OvidMedline]
2
Yadav D, Hawes RH, Brand RE, et al; for North American ...

ADDITIONAL READING

  • Conwell DL, Lee LS, Yadav D, et al. American Pancreatic Association practice guidelines in chronic pancreatitis: evidence-based report on diagnostic guidelines. Pancreas.  2014...

SEE ALSO

Choledocholithiasis; Lupus Erythematosus, Systemic (SLE); Peptic Ulcer Disease; Substance Use Disorders 

CODES

ICD10

K86.1 Other chronic pancreatitis 
K86.0 Alcohol-induced chronic pancreatitis 

ICD9

577.1 Chronic pancreatitis 

SNOMED

  • 235494005 Chronic pancreatitis (disorder)

  • 235952002 Alcohol-induced chronic p...

CLINICAL PEARLS

  • EUS can help differentiate chronic pancreatitis from pancreatic cancer.

  • Pain management is a central component in managing chronic pancreatitis.

  • Pancreatic enzyme replacement therapy alo...

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